A Review of the Cleft Lip/Palate Literature Reveals That Differential Diagnosis of the Facial Skeleton and Musculature is Essential to Achieve All Treatment Goals.

BACKGROUND

After 40 years of monitoring cleft palate treatment results with extensive objective records of cephaloradiographs, dental casts, and photographs, it became apparent that patients with the same cleft type who received the same treatment at approximately the same age were obtaining different results.

METHOD: An extensive review of cleft palate surgical, orthodontic, facial, and palatal longitudinal growth studies was undertaken to determine the critical physical difference between these patients that determined why some treatments succeeded while others failed.

RESULTS

Treatment should be based on performing staged palatal surgery between 18 and 24 months when the palatal surface area to cleft space size is approximately 15% to 20%. Presurgical orthopedics with a gingivoperiosteoplasty causes midfacial deformities.

CONCLUSION

Even though patients have the same cleft type and have received the same surgical treatment, usually between 18 and 24 months, the ratio of cleft and palatal size of 15% to 20% is critical to obtain good palatal development.